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  1. Improving cancer patient care with combined medication error reviews and morbidity and mortality conferences. | PSNet

    psnet.ahrq.gov/issue/improving-cancer-patient-care-combined-medication-error-reviews-and-morbidity-and-mortality
    February 01, 2012 - Study Improving cancer patient care with combined medication error reviews and morbidity and mortality conferences. Citation Text: Ranchon F, You B, Salles G, et al. Improving Cancer Patient Care with Combined Medication Error Reviews and Morbidity and Mortality Conferences. Chemotherapy…

  2. Emergency department volume and delayed diagnosis of serious pediatric conditions. | PSNet

    psnet.ahrq.gov/issue/emergency-department-volume-and-delayed-diagnosis-serious-pediatric-conditions
    September 13, 2023 - Study Emergency department volume and delayed diagnosis of serious pediatric conditions. Citation Text: Michelson KA, Rees CA, Florin TA, et al. Emergency department volume and delayed diagnosis of serious pediatric conditions. JAMA Pediatr. 2024;178(4):362-368. doi:10.1001/jamapediatric…

  3. Risk managers' descriptions of programs to support second victims after adverse events. | PSNet

    psnet.ahrq.gov/issue/risk-managers-descriptions-programs-support-second-victims-after-adverse-events
    May 11, 2016 - Study Risk managers' descriptions of programs to support second victims after adverse events. Citation Text: White AA, Brock DM, McCotter PI, et al. Risk managers' descriptions of programs to support second victims after adverse events. J Healthc Risk Manag. 2015;34(4):30-40. doi:10.1002…

  4. Improving patient safety in clinical oncology: applying lessons from Normal Accident Theory. | PSNet

    psnet.ahrq.gov/issue/improving-patient-safety-clinical-oncology-applying-lessons-normal-accident-theory
    September 27, 2016 - Commentary Improving patient safety in clinical oncology: applying lessons from Normal Accident Theory. Citation Text: Chera BS, Mazur L, Buchanan I, et al. Improving Patient Safety in Clinical Oncology: Applying Lessons From Normal Accident Theory. JAMA Oncol. 2015;1(7):958-64. doi:10.1…

  5. Untenable expectations: nurses' work in the context of medication administration, error, and the organization. | PSNet

    psnet.ahrq.gov/issue/untenable-expectations-nurses-work-context-medication-administration-error-and-organization
    September 21, 2022 - Study Untenable expectations: nurses' work in the context of medication administration, error, and the organization. Citation Text: Hawkins SF, Morse JM. Untenable expectations: nurses' work in the context of medication administration, error, and the organization. Glob Qual Nurs Res. 202…

  6. Factors associated with medication errors in the pediatric emergency department. | PSNet

    psnet.ahrq.gov/issue/factors-associated-medication-errors-pediatric-emergency-department
    March 09, 2022 - Study Factors associated with medication errors in the pediatric emergency department. Citation Text: Vilà-de-Muga M, Colom-Ferrer L, Gonzàlez-Herrero M, et al. Factors associated with medication errors in the pediatric emergency department. Pediatr Emerg Care. 2011;27(4):290-294. doi:…

  7. Disparities in diagnostic timeliness and outcomes of pediatric appendicitis. | PSNet

    psnet.ahrq.gov/issue/disparities-diagnostic-timeliness-and-outcomes-pediatric-appendicitis
    September 13, 2023 - Study Disparities in diagnostic timeliness and outcomes of pediatric appendicitis. Citation Text: Michelson KA, Bachur RG, Rangel SJ, et al. Disparities in diagnostic timeliness and outcomes of pediatric appendicitis. JAMA Netw Open. 2024;7(1):e2353667. doi:10.1001/jamanetworkopen.2023.5…

  8. Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals. | PSNet

    psnet.ahrq.gov/issue/outcomes-missed-diagnosis-pediatric-appendicitis-new-onset-diabetic-ketoacidosis-and-sepsis
    September 29, 2021 - Study Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, and sepsis in five pediatric hospitals. Citation Text: Michelson KA, Bachur RG, Grubenhoff JA, et al. Outcomes of missed diagnosis of pediatric appendicitis, new-onset diabetic ketoacidosis, an…

  9. Quiet please! Drug round tabards: are they effective and accepted? A mixed method study. | PSNet

    psnet.ahrq.gov/issue/quiet-please-drug-round-tabards-are-they-effective-and-accepted-mixed-method-study
    May 19, 2018 - Study Quiet please! Drug round tabards: are they effective and accepted? A mixed method study. Citation Text: Verweij L, Smeulers M, Maaskant JM, et al. Quiet please! Drug round tabards: are they effective and accepted? A mixed method study. J Nurs Scholarsh. 2014;46(5):340-8. doi:10.111…

  10. An evolution of reporting: identifying the missing link. | PSNet

    psnet.ahrq.gov/issue/evolution-reporting-identifying-missing-link
    August 17, 2022 - Commentary An evolution of reporting: identifying the missing link. Citation Text: Harsini S, Tofighi S, Eibschutz L, et al. An evolution of reporting: identifying the missing link. Diagnostics (Basel). 2022;12(7):1761. doi:10.3390/diagnostics12071761. Copy Citation Format: …

  11. The Institute of Medicine report on medical errors—could it do harm? | PSNet

    psnet.ahrq.gov/issue/institute-medicine-report-medical-errors-could-it-do-harm
    February 18, 2011 - Commentary Classic The Institute of Medicine report on medical errors—could it do harm? Citation Text: Brennan TA. The Institute of Medicine report on medical errors--could it do harm? N Engl J Med. 2002;342(15):1123-1125. doi:10.1056/nejm200004133421510. Co…

  12. Variation in the rates of adverse events between hospitals and hospital departments. | PSNet

    psnet.ahrq.gov/issue/variation-rates-adverse-events-between-hospitals-and-hospital-departments
    July 26, 2011 - Study Variation in the rates of adverse events between hospitals and hospital departments. Citation Text: Zegers M, de Bruijne M, Spreeuwenberg P, et al. Variation in the rates of adverse events between hospitals and hospital departments. Int J Qual Health Care. 2011;23(2):126-33. doi:10…

  13. The aging physician and the medical profession: a review. | PSNet

    psnet.ahrq.gov/issue/aging-physician-and-medical-profession-review
    May 27, 2010 - Review The aging physician and the medical profession: a review. Citation Text: Dellinger P, Pellegrini CA, Gallagher TH. The Aging Physician and the Medical Profession: A Review. JAMA Surg. 2017;152(10):967-971. doi:10.1001/jamasurg.2017.2342. Copy Citation Format: DOI Goo…

  14. The confused and bewildered hospital: adverse event discovery, pay-for-performance, and big data tools as halfway technologies. | PSNet

    psnet.ahrq.gov/issue/confused-and-bewildered-hospital-adverse-event-discovery-pay-performance-and-big-data-tools
    September 23, 2020 - Commentary The confused and bewildered hospital: adverse event discovery, pay-for-performance, and big data tools as halfway technologies. Citation Text: Furrow BR. The confused and bewildered hospital: adverse event discovery, pay-for-performance, and big data tools as halfway technolog…

  15. Association between the Centers for Medicare and Medicaid Services hospital star rating and patient outcomes. | PSNet

    psnet.ahrq.gov/issue/association-between-centers-medicare-and-medicaid-services-hospital-star-rating-and-patient
    December 18, 2018 - Study Association between the Centers for Medicare and Medicaid Services hospital star rating and patient outcomes. Citation Text: Wang DE, Tsugawa Y, Figueroa JF, et al. Association Between the Centers for Medicare and Medicaid Services Hospital Star Rating and Patient Outcomes. JAMA In…

  16. Association between elements of electronic health record systems and the weekend effect in urgent general surgery. | PSNet

    psnet.ahrq.gov/issue/association-between-elements-electronic-health-record-systems-and-weekend-effect-urgent
    November 04, 2015 - Study Association between elements of electronic health record systems and the weekend effect in urgent general surgery. Citation Text: Kothari A, Brownlee SA, Blackwell RH, et al. Association Between Elements of Electronic Health Record Systems and the Weekend Effect in Urgent General S…

  17. Using drug knowledgebase information to distinguish between look-alike-sound-alike drugs. | PSNet

    psnet.ahrq.gov/issue/using-drug-knowledgebase-information-distinguish-between-look-alike-sound-alike-drugs
    July 10, 2019 - Study Using drug knowledgebase information to distinguish between look-alike-sound-alike drugs. Citation Text: Cheng CM, Salazar A, Amato MG, et al. Using drug knowledgebase information to distinguish between look-alike-sound-alike drugs. J Am Med Inform Assoc. 2018;25(7):872-884. doi:10…

  18. The "physician-led chart audit": engaging providers in fortifying a culture of safety. | PSNet

    psnet.ahrq.gov/issue/physician-led-chart-audit-engaging-providers-fortifying-culture-safety
    November 20, 2013 - Study The "physician-led chart audit": engaging providers in fortifying a culture of safety. Citation Text: Gitkind MJ, Perla RJ, Manno M, et al. The "physician-led chart audit: " engaging providers in fortifying a culture of safety. J Patient Saf. 2014;10(1):72-9. doi:10.1097/PTS.0000…

  19. Time out! Rethinking surgical safety: more than just a checklist. | PSNet

    psnet.ahrq.gov/issue/time-out-rethinking-surgical-safety-more-just-checklist
    April 27, 2022 - Commentary Time out! Rethinking surgical safety: more than just a checklist. Citation Text: Weinger MB. Time out! Rethinking surgical safety: more than just a checklist. BMJ Qual Saf. 2021;30(8):613-617. doi:10.1136/bmjqs-2020-012600. Copy Citation Format: DOI Google Schola…

  20. Preventable anesthesia mishaps: a study of human factors. | PSNet

    psnet.ahrq.gov/issue/preventable-anesthesia-mishaps-study-human-factors
    June 23, 2015 - Study Classic Preventable anesthesia mishaps: a study of human factors. Citation Text: Cooper JB, Newbower RS, Long CD, et al. Preventable anesthesia mishaps: a study of human factors. Anesthesiology. 1978;49(6):399-406. Copy Citation Format: Goo…
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